Use of PET/CT Examination in Head and Neck Cancer Radiotherapy Planning
Authors:
I. Kolářová 1; J. Vaňásek 1; K. Odrážka 1; L. Petruželka 2; M. Doležel 1; J. Nechvíl 1
Authors‘ workplace:
Oddělení radiační a klinické onkologie, Multiscan, s. r. o., Pardubice 2Onkologická klinika 1. LF UK Praha
1
Published in:
Klin Onkol 2009; 22(3): 98-103
Category:
Original Articles
Overview
Backgrounds:
Using conformal techniques and IMRT in radiotherapy allows dose increase in the target volume and sparing of healthy tissues. In comparison with conventional techniques it requires more accuracy in the target volume delineation. It is important to use all relevant diagnostic methods to reduce the risk of relapse. The basic method is CT examination which allows the dose distribution to be calculated. New imaging dimensions are associated with PET (positron emission tomography), which supplements the morphological image (CT or MRI) with a functional view. The aim of this study was to evaluate the benefit of PET/CT fusion in radiotherapy planning for head and neck cancer.
Patients and Methods:
40 head and neck cancer patients treated by definitive radiotherapy were evaluated. The patient group consisted of 30 men and 10 women, with a median age of 56 years (range 34–81 years). Postoperative radiotherapy was used in 10 cases and 30 patients were irradiated without prior surgery. IMRT technique with simultaneous integrated boost was used with 6 MV photons.
Results:
Comparing diagnostic CT with planning PET/CT, there was no difference in tumour extent in 20 out of 40 patients. In 6 cases (15%) the nodal involvement was more extensive according to PET/CT while in 3 cases (7.5%) the nodal involvement was detected to be less extensive. In 2 patients (5%) the primary tumour was reclassified, in both cases towards tumour enlargement. Two patients with positive histopathological margin were PET/CT negative. PET/CT imaging resulted in a change in the target volume in 11 (27.5%) patients and the treatment strategy was changed in 3 cases.
Conclusion:
We tested use of the PET/CT examination in radiotherapy treatment planning of the head and neck carcinoma and it was introduced as a standard clinical practice at our department.
Key words:
positron-emission tomography – computer-assisted radiotherapy planning – head and neck neoplasms – IMRT
Sources
1. Eisbruch A. Clinical aspects of IMRT for head and neck cancer. Med Dosim 2002; 27: 99–104.
2. Chao KS, Deasy JO, Markman J et al. A prospective of salivary function sparing in patients with head and neck cancers receiving intesity – modulated or three dimensional radiation therapy: Initial results. Int J Radiat Oncol Biol Phys 2001; 49: 907–916.
3. Lin A, Kim HM, Terrell JE et al. Qualit of life after parotid-sparing IMRT for head-and-neck cancer: A prospective longitudinal study. Int J Radiat Oncol Biol Phys 2003; 57: 61–70.
4. Odrazka K, Petera J, Zouhar M et al. Clinical results of intensity-modulated radiation therapy (IMRT) for tumors of the head and neck region. Neoplasma 2005; 52: 85–94.
5. Lee N, Puri DR, Blanco AI et al. Intensity-modulated radiation therapy in head and neck cancers: An update. Head Neck 2005; 29(4): 387–400.
6. Xia P, Fu KK, Wong GW et al. Comparison of treatment plans involving intensity-modulated radiotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2000; 48: 329–337.
7. Lee N, Xia P, Quivey JM et al. Intensity modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys 2002; 53: 12–22.
8. Horová H, Hynková L, Košťáková Š et al. Využití pozitronové emisní tomografie v radioterapii. Klin Onkol 2004; 17(6): 201–202.
9. Dolezelová H, Slampa P. The impact of positron emission tomography in the radiotherapy treatment planning. Neoplasma 2007; 54(2): 95–100.
10. Gambhir SS, Czernin J, Schwimmer J et al. A tabulated summary of the FDG PET literature. J Nucl Med 2001; 42: 1S–93S.
11. Adams S, Baum R, Stuckensen T et al. Prospective comparison of 18-FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer. Eur J Nucl Med 1998; 25: 1255–1260.
12. Bujenovic S. The role of positron emission tomography in radiation treatment planning. Semin Nucl Med 2004; 34: 293–299.
13. Solberg T, Agazaryan N, Goss B et al. A feasibility study of 18F-fluorodeoxyglucose positron emission tomography targeting and simultaneous integrated boost for intensity-modulated radiosurgery and radiotherapy. J Neurosurg 2004; Suppl 3:381–389.
14. Vaňásek J, Kolářová I, Kudelka K et al. Využití PET/CT vyšetření při plánování radioterapie – technické poznámky. Radiační onkologie 2006; 6: 27–29.
15. Koshy M, Paulino AC, Howell R et al. F-18 FDG PET-CT fusion in radiotherapy treatment planning for head and neck cancer. Head Neck 2005; 27(6): 494–502.
16. Ha PK, Hdeib A, Goldenberg D et al. The role of positron emission tomography and computed tomography fusion in the management of early stage and advanced stage primary head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 2006; 132: 12–16.
17. Heron D, Andrade R, Flickinger J et al. Hybrid PET-CT simulation for radiation treatment planning in head and neck cancers: a brief technical report. Int J Radiat Oncol Biol Phys 2004; 60: 1419–1424.
18. Nakamoto Y, Tatsumi M, Hammoud D et al. Normal FDG distribution patterns in the head and neck: PET/CT evaluation. Radiology 2005; 234: 879–885.
19. Lehtiö K, Eskola O, Viljanen T et al. Imaging perfusion and hypoxia with PET to predict radiotherapy response in head-and-neck cancer. Int J Radiat Oncol Biol Phys 2004; 59: 971–982.
20. Eschmann SM, Paulsen F, Bedeshem C et al. Hypoxia-imaging with (18)F-Misonidazole and PET: changes of kinetics during radiotherapy of head-and-neck cancer. Radiother Oncol 2007; 83(3): 406–410.
Labels
Paediatric clinical oncology Surgery Clinical oncologyArticle was published in
Clinical Oncology
2009 Issue 3
Most read in this issue
- Evaluation of Aromatase Inhibitors’ Side Effects in Clinical and Experimental Studies
- Clostridium Difficile Associated Diarrhoea –Problem of Oncological Patient?
- Use of PET/CT Examination in Head and Neck Cancer Radiotherapy Planning
- New Radiopharmaceuticals and Positron-emission Tomography Applications at the Masaryk Memorial Cancer Institute in Brno